From puberty we’ve been taught how to do a monthly breast self-examination and to fear the worst should we find a lump. While any new lump or change in the breast should be investigated by a doctor, a change doesn’t necessarily mean you should fear the worst.

“Most lumps tend to be benign,” says Bridgette Lord, the clinical coordinator at Gattuso Rapid Diagnostic Breast Clinic at Princess Margaret Hospital, Toronto. Cysts are very common in women aged 30 to 50, as are fibro adenomas (benign lumps, likely related to hormonal changes). “So while you shouldn’t immediately worry, I’d rather see someone 10 times and it be nothing than for someone to delay coming in,” says Lord. Book an appointment immediately if you see anything suspicious.

On the other hand, there are other symptoms that are often overlooked, especially when coupled with a healthy mammogram. “Mammograms don’t get everything,” says Lord. “Don’t be falsely reassured by a positive mammogram if you feel that something is wrong. “

To make sure you’re breast aware, here is a list of breast cancer symptoms. If you notice any you should avoid panic – as they are usually a symptom of something quite minor – but book an immediate visit to your doctor.

1. A lump or mass

A lump or mass is the most common sign of breast cancer. Unfortunately these can be difficult to detect in large, dense breasts or if the lump is deep in the breast. They can also be more difficult to detect if a woman has breast implants.

If you do find a mass, hard lumps with irregular edges are the most worrisome. And when it comes to diagnosing breast cancer, pain is a good thing. “Pain is rarely associated with breast cancer,” says Lord. It’s painless lumps that are the most worrisome.”

2. Changes in the skin

Any changes in the skin around the nipple or breast should be investigated. This includes: thickening or dimpling of the skin; finding an even, dense patch of tissue or the retraction or scaling of nipples. Some rare cases of breast cancer can present themselves as an infection so redness or swelling should also be investigated.

3. Secondary areas

According to a recent study in the Journal of Medical Case Reports, breast cancer metastases can sometimes present themselves before a woman is aware she has breast cancer. Swelling around the eye and lumps under the arm can be indicative of breast cancer. (More often, however, they are an infection or allergic reaction.)

4. Nipple discharge

Bilateral discharge that only occurs with expression is not as worrisome as flowing discharge from one breast. If the discharge is also bloody it’s particularly worrisome but can also be a sign of duct problems.